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Benzodiazepine Addiction & Treatment

Benzodiazepines are frequently abused anxiety medications. Nevertheless, overcoming an addiction or dependence on them is possible with treatment.

Benzodiazepines are addictive central nervous system depressants. Often prescribed for anxiety, they are available illegally as street drugs throughout the country, including New Jersey, where the supply has remained steady over the past few years. Stopping a benzodiazepine addiction on your own can be dangerous due to the risk of seizures. Luckily, help is available.

Table of Contents

What are Benzodiazepines?

Benzodiazepines, or “benzos,” are medications that the Drug Enforcement Administration typically lists as Schedule IV controlled substances. In street slang, they are sometimes known as downers. Benzos are FDA-approved for various reasons, including sleep, anxiety, alcohol withdrawal syndrome and seizures. The drugs work by slowing down activity in the brain, enhancing the effect of gamma-aminobutyric acid, or GABA, the brain’s main inhibitory neurotransmitter.

Benzos include:

  • Alprazolam, sold under the brand name Xanax
  • Chlordiazepoxide, previously sold under the brand name Librium
  • Clobazam, sold under the brand names Onfi and Sympazan
  • Clonazepam, sold under the brand name Klonopin
  • Clorazepate, sold under the brand name Tranxene-T
  • Diazepam, sold under the brand names Valium, Diastat and Valtoco
  • Estazolam
  • Flurazepam
  • Lorazepam, sold under the brand name Ativan
  • Midazolam, sold under the brand name Nayzilam
  • Oxazepam
  • Quazepam, sold under the brand name Doral
  • Remimazolam
  • Temazepam, sold under the brand name Restoril
  • Triazolam, sold under the brand name Halcion

Increasing Benzodiazepine Use During COVID-19

Although there has been more than a 12% decrease in benzo use over the past several years, that trend reversed itself dramatically when COVID-19 hit. In early 2020, 81% of mental health professionals reported increases in their clients’ mental health symptoms. More than 36% of Americans in general also stated that COVID-19 was seriously impacting their mental health. Further, in the month between February 16 and March 15, 2020, prescriptions for anti-anxiety medications like benzos increased by more than 34%. This trend impacted women more than men, a nearly 40% anti-anxiety prescription increase in women and a 22% increase in men. Further, demand for illegal street versions of benzos, which may be contaminated with other drugs like fentanyl, has increased during COVID-19.

Related: Survey Shows Drug and Alcohol Use on the Rise During COVID-19 Pandemic

Side Effects of Benzodiazepines

Benzos can have a variety of effects on the body and mood, including:

  • A sense of calm
  • Euphoria
  • Vivid or troubling dreams
  • Amnesia
  • Hostility
  • Irritability

Over the long term, people’s bodies can build up a tolerance to benzos. In turn, the drugs can stop working over time, increasing anxiety levels. Benzos can also lead to dangers like cognitive impairment, especially in seniors. People’s bodies can also become physically dependent on the presence of a benzo, leading to withdrawal symptoms like seizures if someone suddenly stops taking the drug.

Benzos can be dangerous. This is particularly true when benzos are mixed with other drugs that depress the central nervous system, like opioids. The FDA requires benzos and opioids to have a Black Box Warning due to the risk of overdose when the drugs are combined. In 2017 alone, benzos were responsible for 1,498 hospitalizations in New Jersey.

Signs of Benzodiazepine Abuse

Often, signs will indicate a person is struggling with benzo use. Unlike some drugs which may require paraphernalia to use them, benzos are typically prescription drugs taken by mouth. Substance abuse symptoms you may notice include:

  • Social withdrawal
  • Avoiding family or friends
  • Spending lots of time with new friends
  • Ignoring things that once gave pleasure
  • Mood swings
  • Irritability
  • Trouble sleeping, or sleeping at odd times
  • Forgetting appointments or deadlines
  • Problems at work or school
  • Problems with family
  • Reckless behavior
  • Legal problems

Because benzos are Schedule IV controlled substances, health care providers are cautious about prescribing them. Many people who misuse benzos show what are called “drug-seeking behaviors” around health care workers. These include:

  • Asking their doctor for a new benzo prescription before one is due
  • Asking the pharmacy to fill benzos early
  • Claiming the pharmacy did not give as much of the benzo as they were supposed to
  • Claiming they lost their benzos
  • Seeing multiple doctors to get benzo prescriptions
  • Bringing forged benzo prescriptions to the pharmacy
  • Seeking a benzo prescription at urgent care or the emergency room

Signs of Benzodiazepine Overdose

Signs of benzo overdose include:

  • Extreme drowsiness
  • Confusion
  • Coordination problems
  • Diminished reflexes
  • Slowed breathing
  • Coma
  • Death

However, benzo overdoses are commonly complicated by other drugs like opioids: more than 30% of opioid overdoses involve benzos. When benzos and opioids are mixed, overdose signs include:

  • Extreme sedation
  • Slowed breathing
  • Coma
  • Death

Benzodiazepine Withdrawal

Benzo withdrawal symptoms can be unpredictable and may fluctuate. Symptoms can include:

  • Anxiety
  • Trouble sleeping
  • Restlessness
  • Agitation
  • Irritability
  • Trouble with memory and concentration
  • Muscle problems like tension and aches
  • Seizures 

The onset of withdrawal symptoms depends on whether the person has been taking a short-acting or long-acting benzo. If the person has been taking a short-acting benzo like alprazolam, withdrawal symptoms can start within 1 to 2 days after stopping the drug and may last for several weeks. People who take a long-acting benzo like diazepam may experience withdrawal up to a week after they stop taking the benzo. For these individuals, withdrawal may last months.

A Local Story of Benzo Withdrawal

New Jersey resident Lidia Szypulski wrote to the New Jersey State Assembly about her experiences with benzo withdrawal. She was prescribed lorazepam, which she took several times a week for several months. She did not know that stopping the drug could lead to benzo withdrawal. After stopping the drug, she experienced withdrawal symptoms and had to go to the emergency room. She learned that she was in withdrawal and would need to be slowly detoxed from the drug rather than stop it cold turkey.

person being rushed to the emergency room

Benzodiazepine Detox

Detoxing from a benzo under medical supervision can prevent or minimize symptoms of benzo withdrawal. This can occur in a monitored inpatient setting or at home, depending on your needs. Tapering a benzo, or slowly decreasing the dose over time, is a common strategy. However, multiple taper strategies exist. It is important to discuss tapering your benzo with a doctor so that they can help you choose the safest and most effective taper strategy for you. Sometimes, a benzo can be tapered on its own and eventually discontinued. Other times, you are switched to a long-acting benzo like diazepam, and the dose of that benzo is slowly reduced over time. Choices will depend on your medical history, your benzo dose, and how long and how often you have been taking the drug.

Benzodiazepine Treatment Options

The Recovery Village Cherry Hill at Cooper offers multiple treatment programs and strategies to support you as you overcome your dependence on benzos. Our addiction experts can facilitate a comfortable detox as you come off the drug and learn how to live without benzos. Depending on your needs, treatment choices may include:

  • Medical Detox: You can choose to receive around-the-clock medical care as you stop taking benzos, with a medical team available to manage any withdrawal symptoms you experience.
  • Residential Rehab: When the benzo is completely out of your system, you can choose to continue to stay at the facility so you can focus on therapy and your recovery. You’ll explore the reasons you began to rely on benzos in the first place and learn coping strategies for leading a benzo-free life.
  • Outpatient Rehab: After residential rehab, or in place of it if you have a less severe benzo addiction, you can choose to live outside the facility and start your life without benzos while receiving therapy from the facility. Teletherapy may also be available.
  • Aftercare: Rehab is only the beginning of the recovery process. After rehab is complete, aftercare gives you long-term support as you navigate life without benzos. This can include support groups and relapse prevention plans.
  • Dual Diagnosis: For those who struggle with benzos and mental health issues, our dual diagnosis programs can help you come off benzos while also treating your underlying mental health condition.

FAQs

Some common questions about benzodiazepine addiction treatment include:

Benzos work by slowing down activity in the brain, making it harder to stimulate the brain. They accomplish this by enhancing the effects of the neurotransmitter GABA, a brain chemical. As such, benzos are central nervous system depressants.

Many different benzos exist, and they all can stay in your system for different lengths of time. Some are short-acting, while others last a longer period of time. The exact amount of time a benzo will stay in your body depends on your physiology, overall health and organ function, the dosage and how often you take the drug.

As Schedule IV controlled substances, benzos carry a risk of addiction, abuse and dependence.

Benzodiazepines are not opiates. They are similar to opiates in that both benzos and opiates depress the central nervous system. However, they work in different ways to slow down brain activity.

Benzo withdrawal can be unpredictable and fluctuate from weeks to months in some cases. The period of withdrawal and symptoms will depend on which benzodiazepine you are taking. 

U.S. Department of Justice, Drug Enforcement Administration. “2019 National Threat Assessment.” December 2019. Accessed September 20, 2020.

ExpressScripts. “America’s State of Mind.” April 2020. Accessed September 20, 2020.

American Psychiatric Association. “New Poll: COVID-19 Impacting Mental Well-Being: Americans Feeling Anxious, Especially for Loved Ones; Older Adults are Less Anxious.” March 25, 2020. Accessed September 20, 2020.

Moraff, Christopher. “How COVID-19 Is Driving Risks in the Illicit Benzodiazepines Market.” Filter, August 5, 2020. Accessed September 20, 2020.

Turban, Jack; Gold, Jessica. “The Pandemic Is Spiking Anxiety. Before You Take Anti-Anxiety Medication, Understand The Risks.” WBUR, May 18, 2020. Accessed September 20, 2020.

U.S. Drug Enforcement Administration. “Benzodiazepines.” Accessed September 20, 2020.

U.S. Food & Drug Administration. “FDA Drug Safety Communication: FDA warns about serious risks and death when combining opioid pain or cough medicines with benzodiazepines; requires its strongest warning.” September 20, 2017. Accessed September 20, 2020.

New Jersey Department of Health. “Drug-related Hospital Visits.” Accessed September 20, 2020.

National Institute on Drug Abuse. “What are some signs and symptoms of someone with a drug use problem?” Accessed September 20, 2020.

National Institute on Drug Abuse. “Benzodiazepines and Opioids.” March 15, 2018. Accessed September 20, 2020.

World Health Organization. “Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings.” 2009. Accessed September 20, 2020.

Benzodiazepine Information Coalition. “New Jersey Woman Gravely Injured by Benzos Supports Informed Consent.” February 1, 2019. Accessed September 20, 2020.

National Center for PTSD. “Effective Treatments for PTSD: Helping Patients Taper from Benzodiazepines.” January 2015. Accessed September 20, 2020.

Get Help

If you or someone you love is facing an alcohol use disorder, The Recovery Village Cherry Hill at Cooper can help. We offer medical detox and comprehensive rehab programs that are tailored to suit your needs.

Medical Disclaimer: The Recovery Village aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.